Three-Dimensional Computed Tomography Reconstructions Do Not Improve the Interobserver Reliability of the AO/Orthopaedic Trauma Association and Young and Burgess Pelvic Fracture Classifications

Seong-Eun Byun; Jihyo Hwang; Motasem Salameh; Nicholas J Tucker; Michael Hadeed; Austin Heare; Stephen C Stacey; Cyril Mauffrey; Joshua A Parry

doi:10.1007/s43465-022-00637-0

Three-Dimensional Computed Tomography Reconstructions Do Not Improve the Interobserver Reliability of the AO/Orthopaedic Trauma Association and Young and Burgess Pelvic Fracture Classifications

Indian J Orthop. 2022 Apr 24;56(6):1018-1022. doi: 10.1007/s43465-022-00637-0. eCollection 2022 Jun.

Authors

Seong-Eun Byun¹, Jihyo Hwang², Motasem Salameh³, Nicholas J Tucker⁴, Michael Hadeed⁴, Austin Heare⁴, Stephen C Stacey⁴, Cyril Mauffrey⁴, Joshua A Parry⁴

Affiliations

¹ Department of Orthopaedics, CHA Bundang Medical Center, Seongnam, Republic of Korea.
² Department of Orthopaedics, Gangnam Sacred Heart Hospital, University of Hallym School of Medicine, Seoul, Republic of Korea.
³ Department of Orthopaedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
⁴ Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, MC 0188, Denver, CO 80204 USA.

Abstract

Purpose: To evaluate the value of three-dimensional (3D) computed tomography (CT) scans on the interobserver and intraobserver reliability of AO/Orthopaedic Trauma Association (OTA) and Young and Burgess (YB) classifications for pelvic ring injuries.

Methods: Seven reviewers (four fellowship-trained orthopaedic trauma surgeons and three fellows) independently classified 36 pelvic ring injuries using radiographs and axial two-dimensional (2D) CT scan images and then repeated this process 2 months later with the addition of 3D CT images. Interobserver and intraobserver reliability was assessed.

Results: The interobserver reliability of the AO/OTA classification using 2D vs. 3D CT scans was considered fair (k 0.23, CI 0.17-0.29) vs. slight (k 0.16, CI 0.09-0.22), with no observed difference [mean difference (MD) - 0.07, CI 0.16-0.01]. The interobserver reliability of the YB classification using 2D vs. 3D CT scans was considered fair for both (k 0.37, CI 0.32-0.42, vs. 0.37, CI 0.30-0.45), with no observed difference (MD - 0.0005, CI - 0.08 to 0.08). The intraobserver reliability of the AO/OTA vs. YB classifications was considered fair (k 0.35, CI 0.26-0.44) vs. moderate (k 0.49, CI 0.40-0.57), with the YB classification having higher kappa value (MD 0.13, CI 0.01-0.26, p = 0.03).

Conclusion: The addition of 3D CT scan reconstructions to radiographs and 2D CT did not improve the interobserver reliability of AO/OTA and YB classifications for pelvic ring injuries.

Keywords: AO classification; Interobserver reliability; Intraobserver reliability; Pelvic ring injury; Three-dimensional CT scan; Young and Burgess.